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HomeMy WebLinkAbout1383 NIGHTSHADE RD; ; CB980120; Permit.Ca , BUILDING PERMIT Permit No: CB980120 01/19/98 13:51 Prolect No: A9800182 Page 1 of I Development No: Job Address: 1383 NIGHTSHADE RD Suite: Permit Type: ELECTRICAL Parcel No: Lot#: Valuation: 0 Construction Type: NEW Occupancy Group: Reference#: Status: ISSUED Description: TEMPPOWER POLE Appli'ed: 01/19/98 TREVIRA BY MITCHELL DEVELOPMENT Apr/Issue: 01/19/98 Entered By: JM Appl/Owrir : MITCHELL DEVELOPMENT 818 340-5136 - 31225 LA BAYA DRIVE 3119 WESTLAKE VILLAGE CA 91362 01/19/98 000101 02 *** ~RMT 20-00 Fees Required *** **.*_—_...es Collected & Cred1s Fees: 20.00 Adjustments: do, 0/ctl credts: .00 Total Fees: ,OO \ R8 Total .00 / B'1nc\Du'e: 20.00 Fee description / \ •Uñi.)Fee/Unit Ext fee Data . \ / fr?, c- • — / ---. / U Enter "Y" for Electric Issue Fee 10.00 Y Enter "Ye for TemorarService ->------.---, 10.00 Y INCORPORATED 1952 O/JS©S H 1 FINAL APPROVAL. • INSP--- DATL/2- • CLEARAN0E4 - CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 Lk.v..c, FOROFFICE "CC .ONJ PERMft'APPLICATION .' CITY OF CARLSBAD BUILDING DEPARTMENT 2075 LasPaImas Dr., Carlsbad CA 92009 (760) 438-1161 Date________________________ Business Name (at this address) Legal -Description Lot No. Subdivision Name/Number Unit No. . Phase No. Total # of units Assessor's Parcel # . . Existing Use Proposed Use Name - - Address - City State/Zip - Telephone # Fax # Name, . Address - City . State/Zip Telephone # SPROP R MOM 9 Vol ____ ___ Jf/7e/,fL1 'Y-h.T7 e0, /Z24 4 y De. 'J'' . 4 5i,3 Name Address - City State/Zip 7/ %lhone # (Sec. 7031.5 Business and Professions Code: Any City or County which requires -a permit to Construct, alter, improve, demolish Or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he islicensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001). Name : Address City State/Zip Telephone # State License # . License Class City Business License # Designer Name . Address City State/Zip Telephone State License # . W. J Workers' Compensation Declaration: I-hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. . . .. I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: . Insurance Company . Policy No. Expiration Date__________________ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California: . WARNING: Failure to secure-workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code. Interest and attorney's fees. SIGNATURE . DATE ILb I hereby affirm that I am exempt from the Contractor's License Law for the following reason: I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sate. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or, improve for the purpose of sale). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to theContractor's License Law). . . I am exempt under Section Business and Professions Code for this reason: . . I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address / phone number /contractors license number): - I will provide some of the work, but I have contracted (hired) the following pOrsons to provide the work indicated (include name / address / phone number /type of work): - . a OWNER SIGNATURE' "ZW1 LJ-Y L. '' /'/ (.&-... DATE / Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 0 NO is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 -NO Is the facility to bO constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT. HAS MET OR IS MEETING THE REQUIREMENTS OF THEOFFICE OF EMERGENCY SERVICES ANDTHE AIRPOLLUTION CONTROL DISTRICT. - 7V r~RUCn6h~7EWD—INGWAG—EN MR I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code) LENDER'S NAME . LENDER'S ADDRESS_______________________________________________________ I certify that I have read the application .and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cite of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO -SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 50 deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building-or work authorized by such permit is not c menced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after th is en d for a period of 180 days (Section 108.4.4 Uniform Building Code). 01 -- 14P PLICANT S SIGNATURE '- - DATE - WHITE: File YELLOW: Applicant PINK: Finance PLAN CHECK NO EST. VAL. - Plan Ck. Deposit - - Validated By 2:44 SI k1T:iPRWE !NFOHJ4AItQN Address (include Bldg/Suite #)